注射毒品所致感染性假性动脉瘤的血管重建17例

VASCULAR RECONSTRUCTION OF INFECTED PSEUDOANEURYSM IN 17 DRUG ADDICTS

目的探讨注射毒品所致的感染性假性动脉瘤的治疗方法。方法1999年5月～2004年8月,对17例注射毒品所致感染性假性动脉瘤患者的临床资料进行回顾性分析。男16例,女1例,年龄24～38岁。除1例为肱动脉假性动脉瘤外,余16例均为股动脉假性动脉瘤。其中14例接受人工血管原位或旁路移植重建,1例行截肢手术,1例因休克未及时手术致死亡,1例放弃治疗。结果重建血管的14例患者中,13例恢复良好,近期均无远端肢体缺血表现;1例因术后感染再次手术截肢,术后恢复良好。术后3个月复查彩色多普勒显示,9例移植血管通畅,足背动脉搏动良好。结论感染性假性动脉瘤瘤体附近行人造血管重建是非常危险的,但在无适宜自体血管前提下,使用人造血管重建仍是一种有效的治疗方法。术后充分引流、强有力的抗生素及抗凝治疗是关键。

Objective To evaluate surgical treatment of infected pseudoaneurysm （PA） caused by injection of addictive drugs. Methods The clinical data of 17 cases of infected PA caused by drug injection were reviewed retrospectively. Of them, 1 case was female, and the other 16 cases were male, aging 24 38 years. The locations were brachial artery in 1 case and femoral artery in 16 cases. Fourteen cases were treated by artificial blood vessel transplantation after resection of the aneurysm and radical debridement, 1 case by amputation for serious infection, and 2 cases by non-operation for different reasons. Results Among 14 cases treated by prosthetic grafts, 13 cases achieved satisfactory results, no blood drawback of lower extremity occurred after operation; 1 case had to be amputated for serious infection. After 3 months of operation, the color Doppler examination showed that the 9 artificial vessel grafts were patent and the pulse of arteria dorsal pedis was good. Conclusion Though artificial vessel grafting has high risk in the vicinity of infected PA, it is still an effective procedure for revascularization in condition that there is no suitable autogenous conduit available for auto transplantation. Sufficient drainage, anti-infection and anti coagulation therapy should be the key factors after the operation.